As the cost of some lifesaving cancer drugs continues to spiral upwards, I was interested to read an article in which The New York Times reports more than 100 influential cancer specialists from around the world have taken the unusual step of banding together in hope of persuading some leading pharmaceutical companies to bring prices down.


     The doctors and researchers, who specialize in the potentially deadly blood cancer known as chronic myeloid leukemia, contend in a commentary published online by a medical journal that the prices of drugs used to treat that disease are astronomical, unsustainable, and perhaps even immoral, according to the NYT article. It goes on to report that they suggested charging high prices for a medicine needed to keep someone alive is profiteering, akin to jacking up the prices of essential goods after a natural disaster.


     In Blood, the journal of the American Society of Hematology, the doctors began by writing:


The doctrine of Justum Pretium, or just price, refers to the “fair value” of commodities. In deciding the relationship between price and worth (or value), it advocates that, by moral necessity, price must reflect worth. This doctrine may be different from the doctrine of free market economies where prices reflect “what the market bears” or what one is willing to pay for a product. Which doctrine is better? One could argue that when a commodity affects the lives or health of individuals, just price should prevail because of the moral implications.


     While noting that the cost of drugs for many other cancers were just as high, the doctors focused on what they know best: The medicines for chronic myeloid leukemia, like Gleevec, which is enormously profitable for Novartis. Gleevec entered the market in 2001 at a price of about $30,000 a year in the U.S., the doctors wrote. Since then, the price has tripled, even as Gleevec has faced competition from five newer drugs. And those drugs are even more expensive.


     Novartis counters that few patients actually pay the full cost of the drug and that prices reflect the high cost of research and the value of a drug to patients. Additionally, Novartis said in a statement that it provides Gleevec or Tasigna free to 5,000 uninsured or underinsured Americans each year and to date, has provided free drugs to more than 50,000 people in low-income countries.


     Prices for cancer drugs have been part of the debate concerning health care costs for several years. Indeed, Last fall, two Mayo Clinic physicians wrote a commentary in the journal Mayo Clinic Proceedings, saying that among the reasons cancer drugs cost so much in the U.S., is that a virtual monopoly is held by some drug manufacturers due to the way drug treatment protocols work. Cancer care is not representative of a free-market system, and the traditional checks and balances that make the free-market system work so efficiently in all other areas are absent when it comes to most cancer treatment because cancer drugs are administered to patients sequentially or in combination—creating a virtual monopoly for each drug, wrote the authors, Mustaqeem Siddiqui, M.D., an oncologist, and Vincent Rajkumar, M.D., a hematologist.


     In the article, they suggested a determination needs to be made at the time of a new drug approval whether the drug will operate in a monopoly environment. Drugs that are considered to be in such a niche need to be subjected to price controls or more competition. For example, if a drug is approved for the treatment of an advanced cancer for which there is no cure and it is believed that at some point almost every patient with the given cancer will need that drug, it should be considered a monopoly even if multiple options exist for that cancer. In such cases, the given monopoly drug should be subject to some legally mandated price control after the drug is approved, the doctors wrote.


     The NYT article reports that many of the roughly 120 doctors who were co-authors of the commentary in Blood— about 30 of whom are from the U.S.—work closely with pharmaceutical companies on research and clinical trials. The doctors say they favor a healthy pharmaceutical industry, but think prices are much higher than they need to be, and merely call for a dialogue on pricing to begin.


     It will be interesting to see what—if any—industry response occurs. Will Novartis and other companies lower the price of some cancer drugs? Will the articles at least spur some dialog?